PBM Clinical Programs Clause Samples

PBM Clinical Programs. ▪ If elected, PBM’s Manufacturer Assistance Program for Specialty Medications (“MAP”), consists of 1 or 2 components when available, dependent on the specific Plan Design: (1) Accumulator Protection using Manufacturer Copay assistance dollars to help lower Member out-of-pocket costs and Client costs where funds are not applied to member deductible and member out-of-pocket maximum totals; and (2) Accumulator Protection Plus Variable Cost-Share, where plan changes can maximize available assistance funds to offset Plan costs and cover the Member Cost Share but does not apply to their deductible and out-of-pocket maximum, yielding high savings potential, or Therapeutic Interchange Programs where the specialty pharmacy will move Members to preferred agents in order to allow the usage of copay assistance funds from manufacturers. Requires exclusive specialty pharmacy relationship. ▪ If elected, the SaveOnSP program is a benefit design change implemented by PBM in conjunction with a third-party vendor, SaveOnSP. Within the SaveOnSP program, certain specialty medications are classified as non-essential health benefits. In addition, the targeted drugs are assigned higher copays. In all cases, ▇▇▇▇▇▇▇▇ helps the Member coordinate manufacturer-sponsored copay assistance. SaveOnSP targets drugs in six of the top ten specialty categories. SaveOnSP is also available as “SaveOnSP Advantage” for high deductible health plans. ▪ If elected, PBM’s Advanced Opioid ManagementSM program reaches out to physicians, pharmacists and patients at key touchpoints to minimize early exposure to opioids and to prevent patients from progressing to overuse and abuse. Patients will be required to start therapy with no more than a 7-day supply of short-acting medications (with certain exceptions). Member Education will start at the first fill. Prescribers will be notified at the point of care when specific signs of misuse and abuse are observed.